CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 511 1755.75 64851.75 36.94
Subtotal (Total Children Is Unduplicated) 511 1755.75 64851.75 36.94
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 16.00 1200.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.50 187.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 21.50 1193.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 102 118.50 8887.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 119 152.00 8436.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 18.50 1387.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 15 16.00 776.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 11 11.00 533.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 9 9.00 436.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 19 19.00 921.50 48.50
Subtotal (Total Children Is Unduplicated) 171 384.00 23959.25 62.39
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 304 2573.00 128650.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 35 153.50 10419.58 67.88
PHY-97110-PT SESSION BY LICENSED PT 41 202.00 13711.76 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 44 155.75 10572.31 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 2 3.00 39.60 13.20
Subtotal (Total Children Is Unduplicated) 351 3087.25 163393.25 52.93
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Total 5227.00 252204.25 48.25
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Number of Children (Unduplicated) With at Least One Service 613
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Center 57
Flag Claims Units Chgs Paid
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R 242 244.00 9553.50 0.00
U 0 0.00 0.00 0.00
B 369 376.75 15993.25 0.00
P 1257 1337.00 52348.00 52348.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 9 23.50 1182.44 1182.44
1151 3245.75 173127.06 132562.99
Other 0 0.00 0.00 0.00
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Total 3028 5227.00 252204.25 186093.43